The Challenge
Working as nurses at the Philippine General Hospital, a designated COVID referral center, created a multitude of reactions. We were overwhelmed; there were many new protocols and policies to read and absorb and there was a new workflow. There was an escalating anxiety specially for those who will be assigned in the COVID-19 areas.
Nurses were in a “new world”; with many of us being asked to work and lead different lives from before. Our nursing routines had to change and we must strategize to be effective. The lines that separated our personal lives from our work have also blurred with additional concerns for health and family.
Responding to the challenge: What we have done
To ensure that every nurse was aware of the situation, we needed to communicate effectively within the facility and plan for appropriate external communication. A COVID-19 Crisis Management Team composed of doctors, nurses, and members of allied medical professions was created. Issues and concerns pertinent to logistics, human resources, accommodation/housing facility, and infection prevention and control were discussed and resolved together.
There was coordinative teamwork and nurses were the vital link between the patients and the rest of the team. Through assessment and critical thinking, we’re able to notice subtle changes that may indicate patients were getting better or worse. These helped determine the need for referral to subspecialists or changes in medical treatments. More importantly, nurses educated the patients and provided a listening ear or a calming touch via a gloved hand.
The use of Personal Protective Equipment (PPE) was a great discomfort; but part of the adaptation we knew to be the priority in this extraordinary situation. Role changes were necessary for a smooth workflow. The headnurses and senior charge nurses became the Safety Officers, tasked to monitor the correct donning and doffing procedures of the PPEs. These procedures needed to be done slowly and meticulously and the Safety Officers’ role was of utmost importance in this regard. They made sure the PPE fitted well and checked to see that there was no exposed skin; and during doffing, they closely monitored the procedure to prevent contamination.
A shift to electronic documentation utilizing Registry of Admission and Discharges developed by Dr. Homer Co, Coordinator for Services, became the communication tool for drugs and medicine needs, schedules for radiologic and laboratory procedures, documentation of doctors’ orders, and the nurses notes.
To rekindle family ties, the Telekumusta which enabled patients to communicate with relatives was launched and coordinated by nurses. This interaction between patients and family members via the Telekumusta computer in the wards helped decrease anxiety and fears among them.
We had to learn how to use Zoom as platform for meetings and several viber message groups plus the Messenger were utilized for immediate communication, avoiding face to face interactions at all times.
The experience of providing care for COVID-19 patients led to drastic changes in our day-to-day lives as nurses and unintended negative outcomes created immense psychosocial disturbances. Of great assistance was the PGH C.A.R.E.(Counselling, and Assistance Towards Recovery and Empowerment) Society whose members are trained mental health nurses. Interventions were geared towards reinforcing active and positive coping skills that enable nurses to better manage their emotional and psychological reactions.
Nurses learned to identify themselves for their patient’s benefit through their creativity and innovativeness. The photographs, colorful sketches, Disney character drawings, and printed names on our PPEs were personalized approaches for identity.
Visible and Compassionate Leadership
The visible leadership of PGH Director Gerado D. Legaspi was felt by the entire community. He captured what was really happening in the “trenches” of the organization.
All the Headnurses and Chief Nurses were cognizant of the difficulty to manage people or build relationships from behind a desk; hence, they did rounds, interacted, assessed, and intervened together with the nursing personnel.
There was shared learning of new skills as the doctors and nurses worked together. As compassionate leaders, they genuinely believed in what they espoused and shared the benefits of their experiences. They demonstrated commitment with their consistent involvement in the team.
The PGH community is fortunate that our leaders are truly passionate and take the time to demonstrate that passion with visible actions. We were all inspired and felt empowered to do more because of this.
Strategies that work
The following strategies proved their worth through teamwork/ Bayanihan:
1. Share responsibility with colleagues. Nurses in the different nursing units and at all levels must share leadership and from this collective energy, strong networks can be formed that will result in excellence in nursing practice.
2. Create teams for raising more ideas. Teamwork is extremely important because it improves the quality and safety of patient care, makes the nurse’s job more efficient, and helps to improve job satisfaction.
3. Provide access to information for better awareness of the nursing community through infographics.
4. Develop opportunities for experience-based learning to derive meaning and significance from actual patient care encounters.
5. Sustain safety measures for HCW protection including compliance to infection control guidelines.
6. Establish psychosocial support mechanisms to address mental health. These include group and individual stress counselling sessions, tele and email counselling, coaching, buddy systems, and staff support intervention.
Sharing experiences trigger better learning among each individual nurse during this pandemic. Nurses are indeed heroes. As Christopher Reeve puts it, “A hero is an ordinary individual who finds the strength to persevere and endure in spite of overwhelming obstacles”.
Cecilia G. Peña | Published in Healthscape Special COVID-19 Issue No. 9
